Self-injury mental retardation with

Thompson, T, Hackenherg, T, Cerutti, D., Baker, D., and Axtell, S. (1994) Opioid antagonist effects on self-injury in adults with mental retardation response form and location as determinants of medication effects. Am J Ment Retard 99 85—102. 

Lamotrigine is an anticonvulsant drug that attenuates some forms of cortical glutamate release via inhibition of sodium, calcium, and potassium channels. An open-label case series (Uvebrant and Bauziene, 1994) and a case report (Davanzo and King, 1996) described improvement in autistic symptoms and self-injurious behavior, irritability, disturbed sleep, and social impairment in autistic children and an 18-year-old female with profound mental retardation, respectively, who were treated for epilepsy. 

Davanzo, P.A., Belin, T.R., Widawski, M.H., and King, B.H. (1998) Paroxetine treatment of aggression and self-injury in persons with mental retardation. Am J Ment Retard 102 427-437. 

Davanzo, P.A. and King, B.H. (1996) Open trial of lamotrigine in the treatment of self-injurious behavior in an adolescent with profound mental retardation. 1 Child Adolesc Psychopharmacol 6 273-279. 

These instruments have the advantage of being congruent with different behavioral structures observed in MR. They also contain behaviors ordinarily not seen in typically developing children (e.g., pica, stereotypies, and self-injury), and many of them have the added advantage of normative data for young people who are mentally retarded. Hence, the choice of an appropriate assessment tool assumes some specialist knowledge of the field. 

Ricketts, R.W., Gota, A.B., Ellis, C.R., Singh, Y.N., Chamber, S., Singh, N.N., and Cooke, J.C. (1994) Clinical effects of buspirone on intractable self-injury in adults with mental retardation. J Am Acad Child Adolesc Psychiatry 33 270-276. 

Patients with bipolar disorders may benefit from risperidone. This has been observed in an open trial of ten patients with rapid cycling bipolar disorder who were refractory to lithium carbonate, carbamazepine, and valproate eight improved after 6 months of treatment. One patient dropped out through non-adherence to therapy and one because of adverse effects (agitation, anxiety, insomnia, and headache) (5). There was a similar beneficial effect in eight adults with moderate to profound mental retardation (6). Risperidone was associated with a significant reduction in aggression and self-injurious behavior, whereas adverse effects were primarily those of sedation and restlessness. 

Cohen SA, Ihrig K, Lott RS, Kerrick JM. Risperidone for aggression and self-injurious behavior in adults with mental retardation. J Autism Dev Disord 1998 28(3) 229-33. 

A 49-year-old man with severe mental retardation was given clonazepam 2 mg/day to treat aggression, self-injurious behavior, property destruction, and screaming, which got worse instead of better (6). When clonazepam was withdrawn, the behavior improved. 

Self-mutilation refers to deliberate self-injury without the intent to die. It is most commonly encountered in three groups of patients those with organic disorders (including mental retardation), psychotic disorders, and personality disorders. Self-mutilation is often a clinical issue in patients with severe personality disorders who, for example, repeatedly make lacerations (often fairly superficial) on their wrist or forearm. They may describe that, as they watch the blood flow from the cut, it feels as if some internal tension is flowing out of them. 

T. Thompson, T. Hackenberg, D. Ceiruti, D. Baker, and S. Axtell, Opioid Antagonist Effects on Self-injury in Adults with Mental Retardation Response Form and Location as Determinants of Medication Effects. Am. J. Mental Retardation, 99,85-102,1994. 

Disability has heen traditionally associated with mental retardation, extreme mental illness, visual or hearing impairment, physical illness, or injury that affects an individual s mohihty, daily functions, and self-sufficiency. However, according to the World Health Organization, depression is the leading cause of disability (as measured by years lost due to disability), and the fourth leading contributor to the global burden of disease. 

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